RehaCom's new training modules

Brain injury can affect aspects of cognition such our memory, our ability to concentrate and much more.  RehaCom is the premier global tool for computer-aided cognitive retraining.  It has developed since 1986 as a tool for the therapist and now boasts 29 training modules that are aligned to very specific aspects of cognition. 

RehaCom's built-in screening modules can suggest the best training modules to be used and then an individualised training should be planned.

Aspects of cognitive training

RehaCom supports three aspects of cognitive training

  • Restiitution of cognitive function - recovering what can be recovered through specific, carefully designed exercise
  • Reorganisation -  developing and strengthening new neural pathways
  • Compensation - which aims to provide strategies to compensate for what remains a challenge - when complete recovery is not possible. (eg - external memory aids)

It's best not to treat RehaCom in the way you would treat a medication. In other words it is a tool rather than a stand-alone intervention.  It's a tool because how it is used, the frequency and intensity of use as well as which modules to use is best guided by a therapist. For example, a therapist might use RehaCom to illustrate and discuss the difficulty a client is having - brain injured clients may have difficulty in judging their own performance. A therapist might use RehaCom to suggest compensation strategies or encourage the persistence necessary to encourage restitution.

One the concerns about using software like RehaCom has been, "Does performance improvement within the software, translate to functional improvement in the real-world?"

If a therapist approaches using RehaCom as a tool and part of a whole package of therapy the answer to the question above will be yes.

An overview of the RehaCom training modules

New training modules

RehaCom features three new training modules in this release

Sustained Attention

Sustained Attention describes the ability to maintain concentration for a specific task over a longer period of time when confronted with high mental stress and stimuli frequency, which is different to vigilance as a special form of sustained attention under monotonic conditions.

Task settings for attention activation over a longer period of time require the client to constantly focus onmultiple information sources to detect small changes of the objects and react to them.

Sustained Attention/Vigilance training is designed for clients that complain about a decline of concentration or exhaustion with an increased error rate or experienced excessive demands when exposed to intensive mental stress over a longer period of time.

Before the trainings begins, the content and the aim of this scenario should be discussed with the client . The training time should be adjusted to the performance limit of the client and should not reach into the "red area" of overstress/exhaustion. By default, a level is defined for 10 min with a session duration of 20 minutes. In special cases, the training can be increased up to a session duration of 15-20 minutes with an interval of 5 minutes, starting from a level duration of 5 minutes.

Vigilance 2

Vigilance describes states of permanent attention focusing in case of a rare stimuli frequency and stimuli that are rather difficult to discriminate. Vigilance is a special form of sustained attention.

Task settings for the training of vigilance extend to a longer period of time and follow the scenario of "observation tasks" in everyday life, e.g. night-time observation of the air space on a radar, observation of control lights in a power station or control tasks on a conveyor.  They are different from other sustained attention tasks due to the low frequency of "critical/relevant" events and the long time periods during which no changes occur needing attention.

The attention requirements of vigilance tasks are the retention of the attention focus (observation signals) and the attention level (intensity of attention or degree of alertness) as well as to avoid distraction due to mental digression or external events that may occur in the environment.

The training Sustained Attention/Vigilance is designed for clients that complain about a decline in concentration or exhaustion with an increased error rate or experienced excessive demands when exposed to intensive mental stress over a longer period of time. Before the training begins, the content and the aim of this scenario should be discussed with the client . The training time should be adjusted to the performance limit of the patient and should not reach into the "red area" of overstress/exhaustion. By default, a level is defined for 10 min with a consultation time of 20 minutes. In special cases, the training can be increased up to a consultation time of 15-20 minutes with an interval of 5 minutes starting from a level time of 5 minutes.

Memory strategy training

The Learning and Memory Training consists of two training modes: "Mode Nonverbal Learning Disorder" and "Mode Verbal Learning Disorder". In the mode verbal learning disorder, visual memorization is connected with verbal reproduction. In the training nonverbal learning disorder, verbal memorization is connected with visual reproduction. Both modes provide additional learning strategies.

Each task consists of an acquisition and reproduction phase, which are separated from each other by a distraction task. The purpose of the distraction task is to ensure that not only the short time memory is trained but also, and primarily, the long term memory.

During the memory training the client's task is to acquire and apply learning strategies in order to memorize and recall a certain number of objects. These learning strategies should be instructed additionally by the therapist at the beginning of the training session. During the training the respective learning strategy can be viewed again by using the help function.

Patients with brain damage often have difficulties in containing new information and storing and recalling them in the long term memory. In combination of increased distraction and attention disorders these patients have problems to keep an overview and to organize information as the basis of encoding to enable the long term storage, when confronted with a large amount of information. Deficits in the working memory as well as attention disorders inhibit the transfer of the contents to the long term memory.

Such memory disorders may occur after several diffuse brain damages (primary and secondary degenerative brain diseases, hypoxia, infections, and so on..) as well as vascular cerebral damages (infarcts, bleedings), traumatic brain injury and tumors with subsequent bilateral or unilateral lesions.

Memory disorders may also be the result of a neurosurgical intervention, for example to treat epilepsy. Medial temporal or thalamic regions, mammillary body or basal forebrain, gyrus parahippocampalis or hippocampus are structures that, when damaged, generally result inmemory disorders. In case of an infarct, primarily the supply areas of the arteria cerebri anterior and posterior as well as the polar thalamus arteria are of specific importance in the context of memory disorders.

The memory for verbal content is often impaired after a stroke in the left hemisphere and therefore linked to aphasia. Disorders of the visual memory are more likely to occur after damage to the right hemisphere. Impairments of the memory are usually accompanied by other brain disorders such as attention and language disorders.

This leads to confounding effects that complicate neuropsychological diagnostics and severely affect memory tasks (encoding, recall) in daily life. Therapeutic treatments are often hindered by impairments of planning abilities and logicalthinking as well as the patients unwillingness to recognize the necessity of treatment, because a self-reliant use of strategies is often performed in an insufficient manner.

This module has been primarily developed for patients with impairments of long term memory. Furthermore, this training is suitable for patients with an impaired word and visual span, reduced recognition ability and for patients with aphasic disorders as well. Severe attention disorders (training of these deficits with RehaCom module Attention & Focus) and severe deficits of visual perception processes need to be excluded diagnostically.

Conclusion

Three new training modules extend the functionality and application of RehaCom in the domain of cognitive rehabilitation. Full and extensive documentation on each training module is available within the software along with the basic operation manual.

UK clinicians can request a demonstration version of RehaCom